Q Fever

. The Netherlands is suffering from the largest Q fever epidemic ever reported globally In early December new measures were decided upon by the Ministry. Q fever bacteria, which are resistant to heat, drying, and many disinfectants, are excreted in the milk, urine and feces of infected animals, and most abundantly in the amniotic fluid released during the birth of young.
Human beings can contract the disease by breathing in contaminated barnyard dust. Many infections are subclinical, but some may be very serious; causing severe pneumonia and rarely hepatitis and a form of endocarditis. While treatment with antibiotics generally resolves the infection, some victims develop a chronic and more dangerous form of the disease. There have been six deaths.

Recommended paper: "Q Fever in Bulgaria and Slovakia" Extract: ".....Mass vaccination of cattle in Slovakia in the 1970s, followed by selective vaccination of cattle in serologically positive herds and elimination of positive reactors in the 1980s could lessen not only distribution of C. burnetii among domestic animals, but also its transmission to humans. However, absence of vaccination of domestic animals in Bulgaria could contribute to the maintenance of C. burnetii and therefore to increased possibility of human infection, though basic natural conditions for circulation of this agent in either country have been similar. Moreover, gradual changes in agriculture in Slovakia during the 1990s resulted in reduced numbers of cattle and sheep but not in the dramatic increase in goat numbers seen in Bulgaria after the collapse of state farms and cooperative units. One can conclude that in Bulgaria there is a permanent threat of more Q-fever outbreaks unless preventive measures, including improvement of veterinary services and vaccination of domestic animals, particularly goats, are established..."

16 May 2012 ~ An apology for Q fever would help patients

"The victims of Q fever want compensation from the government and goat farmers, and the national ombudsman says the ex-minister should offer an apology. An apology can help, giving the patient some moral support, says Maria Koelen, professor of Health and Society at Wageningen University.

‘It took a long time before the government went into action to halt the spread of Q fever in the Netherlands. And that is what bothers the patients most. After all, it is the government's task to warn people about such health risks and take steps against them. That is why they think the government owes them a gesture. People cannot do anything about their illness, it is just something that happened to them and it is hard for patients to come to terms with it. So it would be good if the ex-ministers concerned now admitted that they took action too late...."

July 28th 2010 ~ Dutch Q-fever bacterium possibly unique

Grateful thanks to Christine Bijl for this translation:

"Wageningen World reported that the Dutch Q-fever bacterium circulating in the goat industry is virulent and has not been found anywhere else in the world.
Various samples of infected people and animals have been genetically analysed by CVI Lelystad. The first results are significant and show that so far 15 strains have been found in the Netherlands, 13 of which also circulate in the goat farms. But one strain dominates and that strain is unique.

"A remarkable result, that has to lead to some conclusion" says researcher Fred van Zijderveld. "Possibly this explains why Q-fever exploded in the Netherlands, and had the ability to make people ill."

The same genetic analysis has been used on the blood samples from dairy goats after abortion. In 238 of 251 analysed samples the same strain was found. A strain that was not found in cattle or mutton sheep, nor in other countries.

"We are trying to find out whether the Q-fever bacterium has mutated over the years, and whether such a mutation is in any way related to intensive (goat) farming. The goats at these farms are like top athletes: they are bred for high milk production, and because of that they have a lot of stress and are close to their physiological limits, says van Zijderveld.
''It could be that this genetic mutation of the bacterium is responsible for the increased number of abortions with the Dutch dairy goats. A mutation also responsible for the virulence and the ability to make people ill."

At the CVI more test are run to find out about the infection route. For this purpose twelve dairy goats have been contacted with the virulent strain in various ways: through the mouth, the nose and the lungs and by injecting the bacterium subcutaneously. “From this research we found that the most likely infection route is by inhaling through the nose and the lungs” says van Zijderveld.
Source: Wageningen World

July 17th 2010 ~Restrictions lifted

ProMed today quotes from a Radio Netherlands report that the Dutch Agriculture Ministry has lifted restrictions on breeding
and transporting milk goats and milk sheep in force
since the outbreak of Q fever. Goat farmers will now be able to "repopulate their
stables". The report reminds readers that 89 goat and
sheep farms were cleared of all livestock during the outbreak. A comment from the ProMed moderator about the 91st farm to be confirmed as infected with Q fever ( a
dairy goat farm in Oirschot, North Brabant) says that the disease was detected by the PCR
testing of milk and seems to have occurred

"... in spite of vaccination, which had been
duly and timely carried on. Vaccination does not rule out infection
altogether, but is expected to significantly reduce bacteria
proliferation and spread by infected animals, and will prevent abortions."

Luckily there is no need to kill the vaccinated flock nor impose a breeding ban
but "to be on the safe side, prescribed biosecurity measures
have been applied."

May 20th 2010 ~
EFSA issues scientific advice on Q fever

" .. It is likely that control methods would need to be used in combination. There is variation in the sustainability of the assessed control options. A number of long-term control options were identified, including preventive vaccination, manure management, changes to farm characteristics, wool shearing management, a segregated lambing/kidding area, removal of risk material, visitor ban, control of other animal reservoirs and tick control. All but the latter two relate specifically to small ruminants. These options are ranked according to effectiveness, as assessed by expert opinion, in reducing spillover from domestic ruminants to humans. Several options were not considered sustainable for long-term control, but may have a role in the face of an outbreak, including the culling of pregnant animals, a temporary breeding ban, stamping out, identification and culling of shedders, control of animal movements and stand still. These options all relate specifically to small ruminants. C. burnetii is highly resistant in the environment; consequently, persistent environmental contamination is a matter of concern. Vaccination can be used both to reduce the risk of future outbreaks (preventive vaccination) and in the face of an outbreak (outbreak vaccination), noting that preventive vaccination is more effective than outbreak vaccination, phase I is more effective than phase II vaccination, vaccination is more effective in non-infected than infected animals, vaccination does not appear to be effective if used in pregnant females, and effectiveness may not be observed in the short-term."

"Co-operation across animal and public health disciplines is key in addressing the risks and challenges posed by a disease such as Q fever. EFSA has therefore worked in close collaboration with the European Centre for Disease Prevention and Control to provide decision-makers with integrated European-level advice on Q fever covering both human and animal health, as well as the transmission of the disease from animals to humans. We need early exchange of information between veterinarians and human health practitioners to better identify the origin of outbreaks in humans and to implement preventive measures when possible. Importantly, we need to all speak the same language and record data in the same way. Harmonisation of data collection is critical in order to define a more accurate picture of the situation in Europe and how it is evolving over time."

May 19th 2010 ~ ".. it's always the outlook of humans that decides the morality of actions. I always wonder who gave us that right."

An extract from a thoughtful and challenging email received today from our correspondent, Christine Bijl, in the Netherlands:

"More and more governments see themselves confronted by the public opinions about animal welfare. And they try to adjust their measures and legislation to gain wide support from the public. They do not seem to succeed very well.
...As for the moral views regarding the Q-fever handling, the animals don't/didn't suffer from the culling. It was done very carefully and well.
The brutality in this case is not the killing but keeping so many animals together.
The little billies (goats) born every year on dairy farms..get separated from the mother after birth and after a few days are sent off to fattening farms and then a few weeks later they are transported again to Spain and Portugal for slaughter. I believe that is immoral.... But the farmers say that it is immoral to kill them without use. As if our use of animals makes it alright to kill them.... it's always the outlook of humans that decides the morality of actions. I always wonder who gave us that right." (read in full)

At a time when many of us are in anguish over the apparent complacency from the UK about the ease with which viruses such as foot and mouth can enter the country, it seems more than extraordinary that there is no real sense of anticipation or urgency from officialdom beyond telling farmers constantly to check for signs of FMD in their animals. The UK has not intention of vaccinating animals against Q fever.

May 13th 2010 ~ "Only when vaccination is
completed in a timely fashion on all farms, would the breeding ban and
the supply ban be lifted ..."

ProMed today carries an English translation of Dutch Miistry of Agriculture, Nature and Food Quality press
release: "...Lifting the ban will also depend upon the continued support for this
step by the expert advisory panel led by Mr Coutinho (director of the
National Centre for the control of infectious diseases, CIB), without
reconsideration." The moderator (AS) says, "..the number of pregnant goats and
sheep, culled on the 88 infected commercial farms (of which 2 were
dairy sheep, the others dairy goat farms), is about 62 500. One
additional goat farm is currently regarded suspected; future addition
of others cannot yet be excluded.
We are unofficially told that the goat sector in the Netherlands is,
not surprisingly, seriously concerned about the situation,
particularly after experiencing the negative impact of the media
publications, 2 months ago, of the preliminary results of the Jeroen
Bosch Hospital milk study. There are doubts about the odds to timely
alleviate/mitigate, as planned, the current measures of breeding and
transportation bans. Final decision will become feasible when the
complementary study in Lelystad is completed and summarised, namely
early June 2010"
Read in full.

April 19th 2010 ~ Q fever in the Netherlands - the costs

Following the latest information about Q fever in the Netherlands indicating that it is a problem "that is still increasing
in size", the ProMed moderator's comment includes the following alarming figures:

"...The number of Dutch citizens, living within a radius of 5 km of
positive farms, to whom a letter informing on the presence of a Q
fever-positive farm in their proximity has been sent, as updated by
the Ministers on 7 Apr 2010, is one million (the total population of
the Netherlands is 16.5 million.... 45 000 animals have been culled, for which
compensations to the owners were 23 million Euros. The costs of the
control measures application, including culling, disinfection,
evaluation, transportation etc have been 11 million Euros. The costs
for vaccination, bulk tank tests and research for 2010 will,
reportedly, be 8 million Euros (this sum seems somewhat
underestimated; does it indeed cover all the relevant 2010
activities?!). Costs related to human health and economy at large
(e.g., hospitalisation, sick days, job loss, etc.) have not been
calculated yet." Read in full

Britain apparently considers the risk of Q fever in the UK to be so low that officials have decided not to vaccinate. No sign of the precautionary principle here. Read ProMed

April 2nd 2010 ~ "most likely to be related to intensive goat farming"

"threat assessments undertaken to date agree that the specific epidemiology of Q fever in the
Netherlands is most likely to be related to intensive goat farming in the proximity of densely
populated areas, factors which appear to be unique to the Netherlands. A risk assessment
undertaken by the Human Animal Infections and Risk Surveillance group in January 2010
concluded that, due to these factors, it is highly unlikely that the events in the Netherlands
could be repeated in the UK....."

March 24th 2010 ~ An important ProMed posting- the Dutch Ministry of Agriculture -- Advice to Ministries of
Agriculture and Health

The posting in full can be read here. Extract: "From the scientific literature we know that during abortion of an
infected small ruminant billions of bacteria are shed in the
environment; during normal partus of an infected small ruminant the
shedding is considerably less, in the range of millions of bacteria.
From the limited data of the field study done by GD and CVI and from
the literature study done by the CVI the preliminary conclusion is
that vaccination reduces the chance of an abortion considerably, and
will probably prevent it almost all together. At the same time there
are indications that a considerable reduction in shedding of _C.
burnetii_ is achieved by fully and timely vaccination of the animals.
The vaccine used in the Netherlands is not (yet) registered in the
EU, but has meanwhile temporary admittance in France."

March 24th 2010 ~ So is the UK considering vaccinating against Q Fever?

It seems that officialdom has decided that an outbreak of Q fever on the scale that is happening in the Netherlands is not possible here ("It could not happen...") Q fever vaccine is therefore prohibited on UK animals. Some might call this the usual overcontrolling and heavy hand of DEFRA.

March 13th 2010 ~ Q fever conference presentations

See below. The presentations can be found at this link. Many thanks yet again to Christine Bijl for her assiduity in communicating with warmwell.com.

March 10th 2010 ~ Excellent Report of February's conference in the Netherlands

We are very grateful to Christine Bijl of the European Livestock Associ\tion for this highly readable and interesting report from the conference that took place in the Netherlands on 25/26 February. It was organised by the Ministry of Agriculture in collaboration with Wageningen UR and
the Animal Health Service.. Read in full

27th February 2010 ~
Most Dutch goat breeders are infected by Q fever

www.agriholland.nl/
reports that
the majority of the Dutch goat holders and their family members are
infected by Q fever.

"This information emerged during the international
congress on Q fever in Breda. Tests, carried out by RIVM, involving 120
goat holders and their family members, showed that 83 per cent of them were
infected by the _Coxiella burnetii_ bacterium. Veterinarians were found to
be infected as well: 80.5 per cent of the 133 tested vets were found to
have had contact with _Coxiella burnetii_.
An investigation covering 5600 blood samples showed that some 2.4 per cent
of the Dutch population has already been infected. For people in close
contact with animals, the percentage is 6.9 per cent"

The ProMed moderator says "this relates, most
probably, mainly to contact with pets; details would help." See full ProMed posting

February 27th 2010 ~ "Health authorities in the Arctic area need to be aware of C. burnetii as a possible infectious agent."

The curious case of the Greenland man who was confirmed as suffering from Q fever in 2008 is here - but what the source of the infection was is unclear. He had never been away from his own part of Greenland - and

"....All imported meat is frozen, and only ultra-high-temperature–pasteurized milk is available. Terrestrial mammals in the area include sled dogs, polar foxes, and a few domesticated cats. Sea mammals include seals and walruses. Polar bears are abundant throughout eastern Greenland; the nearest sheep, horses, and musk oxen are >1,000 km away. There are no cows and goats in Greenland..."

February 25th 2010 ~ Something positive in the latest letter to the Dutch Parliament:

Extracts: "Up till now the false-pregnant animals at contaminated farms were killed
just as the pregnant ones. The experts initially advised to do so for fear
of bacteria in the uterus fluids of
infected false-pregnant animals.
At the request on a majority in Parliament now these animals will be spared.
There will be no additional measures for mutton farms. The experts, chaired
by Coutinho (RIVM) see no need..."
(At 75 farms a total of 43,200 animals have been killed so far.)
The letter to Parliament is to be found in Dutch at www.minlnv.nl/qkoorts Our thanks to our correspondent in the Netherlands for information and links.

February 23rd 2010 ~ "keeping so many animals inside all their lives must be a factor predisposing them to this intense Q fever infection"

Dr Ruth Watkins, the virologist and farmer, writes that in the Netherlands, vaccination will have to continue for at least 10 years as Q fever remains viable in dust even if they have 'cleaned' the farm. The method of keeping so many animals inside all their lives must be a factor predisposing them to this intense Q fever infection.

"If the dominant strain of Q fever in Holland is thought to be more pathogenic, to spread more successfully among the goats and humans than the other concurrent strains, then this is really a similar scenario to highly pathogenic influenza in intensively reared chickens and turkeys- the large readily availabe population of suscetpibles selecting the most rapidly infectious and highly productive strain.
The development of serological testing for Q fever may improve as there has been a publication on the use of heat shock protein B cloned from an animal strain of Q fever used in serological testing, and showing that antibody response to this protein correlates well with recent infection or productive infection as judged by PCR in infected individuals in an infected flock or herd."

ProMed quotes
http://www.minlnv.nl
referring to a
farm including 1050 dairy goats, in Esch 3000 and in Liessel 1030
dairy goats. "The declaration followed the identification of the Q
fever bacterium in each of the 3 farms in 2 separate tests, performed
in both the Animal Health Service (GD) laboratory as well as in the
Central Veterinary Institute (CVI), in 2 different milk samples.
The Food and Consumer Product Safety Authority (VWA) of the Ministry
of Agriculture, Nature and Food Quality (LNV) has placed warning
signs on the farms. The full addresses and the locations of the
infected farms will be made public on the web-site of the VWA."

February 19th 2010 ~ No more culling 2011

The following news items have been gratefully received from our correspondent in the Netherlands. Headlines:

From a veterinary point of view culling will not be necessary to control Q-fever in 2011.

Q-fever detection in bulk milk is based on a DNA-particle of the bacterium.

LNV: culling will probably last till 15 May

Vaccination - a logistical challenge
- Nevertheless it is good news. It makes the future for despairing goat farms somewhat hopeful. The sector will be able to face the future with an entirely vaccinated stock and the breeding ban lifted. Hope is what the goat industry is desperately in need of and entitled to.

February 17th 2010 ~ PCR testing

While a positive result is reliable, a negative reading unfortunately may not prove absence of infection. The ProMed posting and moderator explanation should be read in full. (Link mended.)

Feb 16th 2010 ~ 2nd dairy sheep plant with Q fever

In January [2010], a dairy sheep farm
in Kraggenburg was found infected.
Now the Dutch Food and Consumer Product Safety Authority (VWA) have announced that a
dairy sheep farm in Stolwijk, South Holland, has been declared Q-fever
infected.
In addition, another dairy goat farm in Haren, North Brabant, has now
been declared infected. The current total number of Q-fever infected
farms found in the Netherlands [since 1 Oct 2009], is 73 [of which 71
are dairy goat farms]. SourceAs for numbers of human beings infected, many people whose disease is eventually cofirmed only reported symptoms to their doctors because the
disease is in the news. ProMed notes that "The incubation period for acute Q fever in humans varies
from 2 to 48 days; the typical incubation period is approximately 2 to
3 weeks. Chronic Q fever can occur from months to years after
infection."

"...
The EFSA's Panel on Animal Health and Welfare (AHAW) will lead the work with the support of the Panel on Biological Hazard Panel (BIOHAZ) and in close collaboration with the European Centre for Disease Prevention and Control (ECDC). A scientific opinion is expected by the end of April 2010."

Let us see no knee-jerk draconian measures but rather a consideration of the conditions imposed by humans in which q fever is able to flourish. As an emailer wrote recently:

"..the animals have been scape-goated for hysteria around symptoms which - though bad and I do not underestimate the illness of some patients - has led to draconian measures based on the slightest degree of infection at a farm.
The fact that we now know that last year 2300 people became more or less ill, some badly ill, is mainly due to the fact that every case where there are symptoms is being tested for Q-fever. Before 2007 this test was not done as a standard,so hardly any patients were found. So how do we know that 2300 is a high number?What we do know is that thousands of people get winter flu every year, and around 800-1500 a year die. In the past 3 years 6 people have died from Q-fever; they already had other illness and were therefore already in a bad or weak condition. I know that we should not underestimate Q-fever, but still I have a strong feeling that the whole handling now is over the top."

Read in fullMost warmwll readers may well agree with correspondents whose view of this disturbing matter can perhaps be summed up by one emailer who says, ".... testing is never really conclusive unless several tests show the same result. And measures should not be taken on one single sample. But this is what the experts' group has decided and they are dominated by public health interests. But all in all my ‘j'accuse' goes to intensive farming."

Feb 6 2010 ~ Goat cull halted after Q fever test problems

The Dutch News "The slaughter of hundreds of goats on an intensive goat farm in
Limburg was halted following a court order on Friday
because test results for Q fever were inconclusive. It is the first time
a court has stopped the cull procedure, which covers all pregnant
goats on farms where Q fever has been found.
The farm owner applied for an injunction to head off the cull after
tests for the disease came up with conflicting results. He wants vets
to take new samples and have them tested in different laboratories to
find out if his herd really is carrying Q fever.
The judge will explain his ruling on Monday, news agency ANP reported."

February 5 2010 ~ EFSA conference is to be held on 25 and 26 Feb 2010 in Breda, south
Netherlands under the title "One Health in relation to Q-fever, in
humans and animals"

The ProMed moderator comments: "Reportedly, the purpose of the conference is to
collect and discuss information and experience from those countries
around the world which have experienced Q-fever outbreaks themselves.
The plenary session is planned to include contributions from a number
of scientists from Canada, Australia, France, Germany, Hungary and the
Netherlands, as well as presentations of EFSA and ECDC. The following
URL is available on OIE's website: http://www.cvi.wur.nl/NL/onderzoek/dierziekten/Qfever/International_conference_Q-fever_registration/

30 January 2010 ~Q Fever. Culling in the Netherlands has been put on hold.

In view of the current consulation on the UK's AHS draft strategy and regulation, with its emphasis on killing before testing is done, it is interesting to see that MPs of the Dutch Lower House ( Radio Netherlands article on Jan 28) have forced a temporary halt in the killing of goats in the Netherlands, by suggesting that the culling of untested animals for Q fever is "too drastic" and have recommended that the
animals should first be tested individually. Minister Verburg is against the
motion but has agreed to wait for the outcome of next week's
parliamentary vote on the issue planned to take place on February 2nd. As the ProMedmoderator says,

"On top of animal welfare aspects of the issue, there are significant
zootechnical/economical ones. Male breeding animals are selected
according to their genetic potential, their monetary value usually
much higher than that of the females and may go into 4-digit figures
or even more, in Euros. They may represent many years of breeding
efforts and investments."

30 January 2010 ~ plans to cull thousands of potentially infected animals were reportedly put on hold after a parliamentary debate

We read on ProMed on Jan 28 that "MPs said the measure was too drastic and have proposed that the
animals be first tested individually. Minister Verburg is against the
motion but has said she will await the outcome of next week's
parliamentary vote on the issue."
The website Emerging Health Threats says,

"The move temporarily overturns an earlier decision, made by Health and Agriculture Ministers, to cull male goats and sheep in addition to thousands of pregnant females in infected farms. With a vaccine shortage and difficulties telling apart infected from healthy animals, the Ministers believe an expanded cull can minimise the risk of further spread.
Experts say the country is facing a long fight as many question marks remain over how the outbreak began, and what puts people at risk of getting infected with the Coxiella burnetti bacteria that cause the disease. Robert Massung, Chief of the Rickettsial Zoonoses Branch of the Division of Viral and Rickettsial Diseases at the US Centers for Disease Control and Prevention in Georgia. is quoted, as saying there is no single answer to how the Dutch epidemic happened.

"Unfortunately for the Netherlands, this appears to have been a 'perfect storm' scenario.
A "unique combination" of factors created ideal conditions for the outbreak beginning with a high density of commercial dairy goat farms after a rapid expansion of the goat farming industry over the past 15 years. These animals are often transferred among farms - a practice that helps the spread of pathogens.
The same area that hosts animals that make up a 'reservoir' of Q-fever bacteria also hosts a dense human population with little or no existing immunity. A lack of awareness may also have helped the epidemic to pick up speed. Early on in the course of the outbreak, people probably had little knowledge of the disease, he says, which until then had affected mostly people who work on farms."

The article says that vaccine, which can prevent abortions and some infections, was in short supply in 2008 and 2009. "But enough doses should be available this year, according to media reports."

January 26 2010 ~ For the 1st time, Q-fever has been detected on a dairy sheep farm.

We read on ProMed Mail that the infected farm, in Kraggenburg (Flevoland) has about 150
pregnant sheep, which were due to be killed yesterday (Monday)
The situation in both dairy and mutton flocks is to be discussed on
Wednesday [27 Jan 2010] in an emergency debate in the Dutch Parliament with
Ministers Verburg (Agriculture) and Klink (Public Health).
A translated article from Brabants Dagblad is quoted:

"Ahead of the parliamentary debate, the ministers will clarify their
policy concerning measures against Q fever on sheep farms ... bulk-milk tests were the mode upon
which actions on [dairy] sheep farms were determined. Mutton-sheep
have not been addressed so far ...
In the due emergency debate, the VVD party (Dutch liberal party) will
argue for a parliamentary investigation into the control of Q-fever.
According to the VVD, the inquiry set up [see 20100112.0144] has no
access to the cabinet's files..."

It appears that various research reports and other
documents have shown that the Q fever bacteria was first discovered on goat farms in the south of the country in
2005 but their locations
have remained secret.
In 2007, the disease was discovered in humans but it was only at
the end of 2009 that the government decided to adopt drastic control
measures.
ProMed moderator comment: (Extract): "Q fever in sheep and goats has become officially notifiable in the
Netherlands since 2006. According to OIE's WAHID interface, this
disease is still not notifiable in several European countries such as
Belgium, Finland, France, Portugal and the UK, as well as in most of
the world's countries, including Australia, the "cradle" of Qf, and
Canada, where massive outbreaks in goats have been recorded in the
past. Declaring a disease as notifiable is the inevitable,
prerequisite step required to regulate and implement official disease
control or preventive measures. Q fever in cattle is not yet
notifiable in the Netherlands....
It will be interesting to follow the deliberations and testimonies of
the Dutch investigation committee(s); their conclusions and
recommendations may have an impact upon Dutch policy and regulations
and also elsewhere within and outside Europe. - Mod.AS]

January 21 2010 ~Dutch correspondent: "As usual, the media are playing a bad part in this"

The email continues: "People have little idea of what is going on, yet they hear about goats and sheep causing people to get really ill, even dying. And immediately hysteria reigns. The minister has decided not to issue the measures for small-scale and hobby farms - and then some town, anticipating the nearing council elections campaign, decides to make a good impression by taking these disproportionate measures. Yes, people get sick, yes some very seriously - and some with other already existing health problems die. That's very bad, but most people have no symptoms or mild flu-like symptoms. So the hysteria is over the top. I really hope we are not going to have some kind of witch hunt situation."

January 21 2010 ~ Sheep and goats kept on non-commercial holdings will be isolated from the public

We hear from the Netherlands that
three hobby holders in in the Houten area, near Utrecht, are having to isolate their infected sheep and goats. No visitors are allowed. Now that the minister has decided to impose a hygiene protocol to city farms (petting farms), the mayor and aldermen believe it should be imposed on the goats and sheep kept by hobby holders as well. The decision has been taken in consultation with the GGD (Public Health Service).
These hobby holders have respectively 1, 2 and 20 animals (sheep and goats). The premises are located just at the border and in the outside area of the municipality of Houten. Some people in Houten became ill last year. There is a contaminated commercial farm in the neighbourhood of Houten (Bunnik).
Spokesman Jeroen Pater says that they will possibly make an agreement with the hobby holders. Pregnant animals should be kept apart, out of sight of passers-by; they must be isolated during lambing and no visitors are to be allowed. He could not say as yet whether signs will be put up at the premises. He believes that soon the addresses will be known anyway.

January 18 2010 ~ "How could it have got to this point: that people became ill and animals had to die?"

"....23 July 2007 those whose job it is to protect the Dutch population from outbreaks of infectious diseases had asked for data on infected premises. They did not get them. Accordingly they could not get proper insight in how the disease spread, says the news broadcast.
Besides infected farms were not under any obligation to notify the authorities of the disease, even though policy makers were aware of the risks to public health...Various measures were postponed for a long time; meanwhile Q-fever was spreading further because a farm would only be declared infected if more than 5% of the pregnant animals were aborting. Large farms where Q-fever infection remained below 5%, did not have to take any measures at all - and in the mean time, billions of bacteria could spread, infected goats were able to be transported all through the Netherlands, infected manure was spread and ploughed in other provinces and the Q-fever bacterium blew over the whole of the Brabant countryside. People got ill. People were hospitalised with serious pneumonia. People got chronic heart valve infection. People died. And people got angry..."

January 13 2010 ~ " At small-scale farms there are fewer animals that could excrete the Q-fever bacteria. Therefore these farms are of less risk to public health and therefore the pregnant animals at these farms will not be killed."

A translation of yesterday's Official information e-mail by the ministries of Agriculture and Public Health in the Nethelands has been gratefullyreceived at warmwell.com and can be read here. Many thanks again to our Dutch correspondent.

January 13 2010 ~ "I truly believe this time they are trying hard to do things correctly... however gruesome they are."

Our Dutch correspondent says that the Dutch are not people to just go along easily with the Authorities. The letter below (translated by our correspondent for which we are very grateful) does, however show that genuine efforts are being made to minimise animal distress during the deeply unhappy situation in the Netherlands:

Your Excellence,
During the third and first complete [the other weeks were cut by holidays] week of culling the committee has again visited the farms where goats were killed. Again the weather conditions were wintry, so workers in the fields and stables were cold. We found however that this did not affect animal welfare. The work was organised in such way that the animals did not suffer from the winter cold. The teams at work were clearly well trained for the job. They were well aware of previous advice given by the committee regarding sedation (dosage, rest).
Again we saw that the presence of and cooperation by the farm vet was regarded as very positive. The owners of the farms visited were not present during the culling, but had delegated their responsibilities to their vet, who was present all the time.
During this third week a group of researchers has tried to collect fluid from the euthanised goats without having to open the animals. The committee has established that this work has in no way harmed the welfare of the goats, not the ones still alive nor the dead ones.
The committee is of the opinion that the VWA*-teams earn praise for the internalised way that they have integrated animal welfare.
Our inspections will continue to take place at random and without notice in the coming weeks.
Prof. Dr. HENK VAARKAMP
Prof. Dr. FRAUKE OHL

*Food Safety Authority

January 8 2010 ~ " the farmers want more than sympathy. A newly formed association is considering a lawsuit."

See The Economist "A mainstream farmers' union is negotiating with the government about other kinds of help - though bigger payouts would risk breaking EU rules on subsidies.
The question now is whether this outbreak will remain limited to the Netherlands, where large numbers of big goat farms in the south of the country may have formed fertile ground for the disease. If it spreads elsewhere in Europe, it could become a wider agricultural calamity, like the foot-and-mouth epidemic in Britain of 2001. But unlike foot and mouth, Q-fever infects people." Read in full

Gratefully received from the Netherlands
- this update translated into English:

Ministers Verburg (LNV/Agriculture) and
Klink (VWS/Public Health) have sent a letter to Parliament today about the
activities regarding Q-fever control.In this news letter you may find
the main points in that letter. You may also find the info regarding the
modifications for bulk milk monitoring, info re the sentence on 4 January 2010
by the Board of Appeal for Commerce and Industry, and an overview of all
information sources.

Update on the cullings

At the moment 61 farms have been declared
contaminated based on bulk milk testing results. We expect to have the results
of the current bulk milk tests next week. At 24 contaminated farms animals have
been scanned to distinguish the pregnant and not-pregnant. Next all pregnant
animals at these farms have been valued. So far a total of 8724 animals at 21
farms have been culled.

Small-scale farms and 'children's farms'

Minister Klink has asked the experts' group to advise him
about the health risks of Q-fever at 'children's farms', farms with less than 50
animals and farms with a public function. According to the experts no extra
measures need to be taken regarding this cluster of farms.

The experts believe that direct contact with sheep and
goats is not a risk factor. Recent research data also show that Q-fever bacteria
are hardly ever found at 'children's farms'. There is no indications that
'children's farms' and other small-scale farms have a higher health risk to the
public.

The experts advised however to take pay extra attention to
hygiene measures. Therefore a hygiene protocol will be made for the small-scale
sheep and goat farms. As soon as this protocol is available, it will be
published on the website page 'Hobbydierhouders en dierhouders met een publieke
functie' (Hobby holders and animal keepers with a public function)

For hobby holders and animal keepers with a public
function (like children's farms) notification to the VWA (Food Safety Authority)
in case of an abnormal number of abortions was already obligatory. After
notification the VWA then investigates the farm. This already was standard
procedure in case of any abnormal number of abortions. Now in case of an
abortions notification the (new) VWA-procedure includes not only the usual
testing for the Brucella melitensis bacteria (causing Brucellosis) but
also testing for the Q-fever bacteria (Coxiella burnetii).

The experts'group led by the RIVM (National Institute for
Public Health and Environment) has already advised on 24 July 2009 that meat
sheep farms create no risk in the Q-fever epidemic. However, in
the huge straw stables at the large-scale meat sheep farms large numbers of ewes
(female sheep) will start kidding at the same time soon. Therefore it is
decided that for these large-scale farms the same precautionary policy will be
issued as for small-scale farms with less than 50 ruminants. So the advice in
the hygiene protocol for small-scale farms and 'children's farms' will be
applied to meat sheep farms as well.

The Q-fever letter to Parliament

Judicial verdict

On 4 January 2010 the judge of the Board of Appeal for
Commerce and Industry has passed sentence on account of the request from a goat
keeper to spare from culling the animals kept at a different location, although
registered under the same company number as the contaminated farm.

The request from this goat keeper has been denied. According to the
judge both locations are connected units of one company, as goats have been
taken from one location to the other. At the location, according to the
goat keeper Q-fever free, are the off-spring of goats, that are either
infected themselves or from the same flock at the location where the Q-fever
bacteria have been found in bulk milk samples. Besides the goats that are from
the Q-fever free location have not all been vaccinated in time.

Modifications for bulk milk testing

In one point the measures for bulk milk testing have been
modified starting on 30 December 2009 at 4 PM. Some 50 of all 411 dairy sheep
and goat farms sent their milk samples for monitoring to the Animal Health
Service (GD) themselves. The modification of the Regulation for bulk milk
monitoring means that now the GD will collect the samples themselves. At all the
other farms bulk milk samples were already taken by Qlip (independent
service for the Dairy sector) on the location itself. In the press release
“Modification Regulation bulk milk monitoring“ you may find more information
about the modified Regulation at http://www.minlnv.nl

"The combination: 1st anesthesia, then euthanasia by an experienced
team of workers of the Food and Goods Authority in collaboration with
the private farm's veterinarian, seems the preferable mode for
culling of goats from a welfare perspective. This was proposed by the
Vaarkamp-Ohl committee, the welfare committee which has been
appointed to watch over the measures against Q fever and their
animal-welfare-wise responsible application. Their report on the 2nd
week of the culling has now been released.
During the 2nd week of the operation, the committee paid 2
unannounced inspections at culling locations in different regions. It
was found again that the workers treat the animals with respect and
caution. There is virtually no bleat to hear; escape nor anxiety
behavior of the animals were not observed. High sedative doses were
found to be most effective."

December 23 2009 ~ "Our results show that the unprecedented, ongoing Q fever outbreak in the Netherlands involves multiple genotypes of C. burnetii"

A letter in the EID Journal Volume 15, Number 4 - April 2009 from Klaassen CHW et al, on the subject of the genotypes present in the situation in the Netherlands, notes that ".. incidence rates have increased >50-fold compared with the baseline rate (2). The source of this outbreak is unknown. Identifying the source of an infection is complicated because of difficulties in obtaining sufficient clinical and/or environmental samples for testing.

"... we were still able to distinguish 4 different genotypes in a relatively small collection of serum samples. .."

December 22 2009 ~ "Inexcusable," says Dr Watkins, "that the Q fever outbreak in Holland was allowed to grow over 3 years to a situation they can only handle by slaughtering.."

Dr Ruth Watkins is rightly incensed by the situation in the Netherlands. As she says on Twitter, "Vaccination of uninfected young female goats before they are put to the Billy for the first time with killed phase 1 Q fever vaccine works well We are not allowed to use this vaccine for our domestic animals; EU and DEFRA prohibit it - yet it can be used for humans who are at high risk. She adds that she is cynical about the Dutch chief vet's claim that this Q fever strain is "uniquely more pathogenic" As she says, "Killing 10 000s pregnant goats is awful. " Will lessons be learned from this?

The situation in the Netherlands is very grim. A very helpful Dutch correspondent has translated the letter. It seems that the vets are still reluctant but also realize that a job has to be done to protect people next year. There simply is no time for elaborate individual testing. And without time and several tests one cannot be sure of infection. The situation has, many would say, been brought about by the intensification of farming goats. Such farmers could have taken responsibility by not breeding this year instead of waiting for the Minister to tell them - it did advise them to wait till after vaccination - but because the season would have been practically over, many just hoped for the best. And now we are faced with a cruel and distressing situation. Excerpt from the letter:

"To
Ministry of Agriculture, Mrs A. Burger,
Ministry of Public Health, Mr P.H. Huyts
Excerpt: " ..Concerning non-vaccinated farms with positive bulk milk test.
What effect can we expect from vaccinating pregnant animals?
There are no reliable data available. ...
The experts believe that vaccination of pregnant animals does not result in the desired effect on
excretion of C. burnetii."

Her email today should be read in full on the Q fever page with its suggestions for what should be done as a matter of great urgency. Then she adds, "... Instead of just killing everything and learning very little this would be a way of containing the situation. Spread at the abattoirs is certain, and possibly en route from births in the transport, and there is still the removal of infected dust at the farms to be worked out too." Read in full

"... With 2300 human infections and six deaths from the disease so far, all the papers report Animal Rights party leader Marianne Thieme's damning verdict that the government is guilty of "culpable homicide" for failing to act and putting lives at risk. The broadsheet, de Volkskrant, agrees with Ms Thieme that the government has been dragging its feet on Q-fever.
lives at risk. The broadsheet, de Volkskrant, agrees with Ms Thieme that the government has been dragging its feet on Q-fever. The paper points out that while the A(H1N1) flu virus has been grabbing the headlines, the obscure goat disease has been left in the shade....
Trouw agrees that the government has not had its eye on the right ball, pointing out that Q-fever is usually more serious than A(H1N1) flu, causing high fever and health problems that drag on for months.".....In an interview with AD, Thieme stood by her accusation and blamed the Christian Democrat party, the senior coalition partner.

"The Christian Democrats support factory farming, and that's a dead end," she said, hammering home her view that "our kind of intensive livestock farming in a highly populated country is asking for trouble."

December 12 2009 ~ "We are heading towards a disastrous situation." Q fever slaughter plan - vets do not want to go through the trauma of killing healthy, pregnant animals

Many veterinary surgeons in the Netherlands have already said they are not prepared to cooperate in the official policy against Q fever which involves the killing of uninfected, healthy animals. Ludo Hellebrekers, president of the Dutch Veterinary Society (KNMvD) is quoted (in Dutch) at mobiel.volkskrant.nl

"We do not want to go through the trauma of the culling operations during the pig and bird flu again,"

The KNMvD is pleading for all animals on infected farms to be tested for the Q-fever bacterium first. Laboratory capacity and the time necessary to examine the many blood samples are problems - but Hellebrekers says: "If necessary, we'll run the laboratories 24 hours a day or send samples to laboratories abroad." Vets are also most unhappy about proposed methods of slaughter.
In order to avoid media images of grab cranes full of dead animals reminiscent of the darkest days of 2001, the Minister of Agriculture, Gerda Verburg wants the pregnant goats to be killed in slaughterhouses - but the lambing season (and premature births) are already imminent - and there are also doubts about method of slaughter. In slaughterhouses, animals are stunned and hung up, unconscious, to bleed to death from a hook. But the lambs of pregnant goats will live on for a while and, says Hellebrekers, many of the vets who supervise slaughterhouses find it "ethically unacceptable" for the unborn lamb to die a slow death.
There are health risks for slaughterhouse workers and butchers involved in contact with the bodies of infected goats while transporting pregnant goats can lead to premature births - with the risk thus releasing of Q fever bacteria into the truck. Highly pregnant goats are not allowed to be transported anyway. As one emailer from the Netherlands says, "We are heading towards a disastrous situation." And once again, one wonders why on earth the vaccine was not eagerly made use of as soon as the outbreak of 2007 came to light.

December 10 2009 ~ ProMed moderator latest comment: cattle, dogs and cats, are not to be disregarded

See full posting: "While small ruminants, namely goats and sheep are traditionally
regarded as the main potential source of human infection, other
animals, such as cattle, dogs and cats, are not to be disregarded. In
urban areas, littering cats have been seriously suspected as a
significant source of human infection. In the Dutch context, the
earlier (1997) review "Q fever in Europe" is of interest. It included
the following text:

"In some human cases, no relation with
"classical" sources can be found, and possible new sources must be
sought. In a serological study of dogs and cats [in central
Netherlands, 1992], 13.2 percent (91/688) of dogs and 10.4 percent
(46/441) of cats were found to be positive for specific antibodies
against _C. burnetii_. This implies that cats and dogs may be a
source of infection. Special attention to hygiene during parturition
may be needed."

December 10 2009 ~ Vaccine Coxevac made by Ceva in France, has been available and is effective if given before pregnancy in preventing Q fever infection

Dr Ruth Watkins shares the anger felt by many at the slaughter of 20,000 pregnant goats. Her email expresses anger about the killing of 20 000 pregnant goats and sheep at dairy farms in the Netherlands - a policy that resembles the FMD misery in that a vaccine, Coxevac, made by Ceva in France, inactivated phase 1 Coxiella burnetii organisms, has been available and is effective if given before pregnancy in preventing Q fever infection. If not completely blocking infection it does prevent shedding - particularly in kids and lambs. She explains that while France may allow its use, neither the Netherlands nor the UK allow it. Consequently, when the outbreak first occurred in the Netherlands the vaccine was not allowed. There has been delay in allowing its use in the Netherlands and it is still prohibited in the UK. Read email

December 9 2009 ~ On farms with Q-fever where goats have already been vaccinated, infected animals will be slaughtered, whether they are pregnant or not.

In the Netherlands, Agriculture Minister, Gerda Verburg, and the minister of Health, Welfare and Sports, Ab Klink have announced tough new measures during a special press conference tonight. On farms (outside the infected area, where vaccination was voluntary) where Q-fever vaccination did not take place, all pregnant animals will be slaughtered, regardless of whether they are infected with the disease or not.
According to the article hereby Stef Severt of the Agrarische Dagblad,
many details about the implementation of the policy remain unclear - including the issue of possible compensation for stock breeders. Consultation has already taken place with Brussels.

The measure seems to be going to be applied to farms where the results of tank milk sampling (PCR-testing) repeatedly demonstrate Q-fever infection - and the culling should be a onetime measure before lambing or any abortions take place.Reuters of India reports: "Dutch authorities will start slaughtering sheep and goats at farms which have been hit by the highly infectious disease Q fever to stop it spreading to humans, Dutch ministries said on Wednesday." Dutch Agriculture Minister Gerda Verburg is quoted:

"On farms that have vaccinated animals, all animals would be tested for Q fever and those contaminated will be culled
On farms that have not carried out vaccinations, pregnant animals will be culled in addition to contaminated animals. The measures we have taken so far have helped, such as the obligation to vaccinate in some areas. Therefore we can expect a strong decline of cases with humans in 2011. But we also want to do the maximum to limit the consequences next year."

The measure affects 55 farms in the Netherlands, but Verburg declined to estimate how many sheep and goats would be killed. Goat rearing in Holland has become an intensive industry.
As one emailer remarked recently: "..replacing cows and sheep for intensive goat farming in sheds. And BINGO! What idiots people are..."

"In the Netherlands 55 farms are officially infected with Q fever.
This is reported by the Food Safety Authority (VWA) and is the result of research for the Q fever bacterium Coxiella burnetii in bulk milk. For thirteen farms the outcome is still uncertain. "These farms are being further investigated. Then they will be officially declared contaminated or not," said a VWA spokesman.
The number of infected farms is significantly lower than expected. Based on previous research for antibodies against Q-fever the estimation was that 30 percent of the 400 goat farms (120) would be infected. It appears now to be between 14 and 17 percent. The number of infected farms is also well below the provisional figure of 76, that was announced in November.
Jan van Lokven, Chairman of the LTO (Argricultural organisation) Netherlands dairy goat sector, welcomed the figures. "It is considerably lower than expected. This gives us good hope that the measures taken will work. If there are fewer infected farms, the industry will be free of Q-fever sooner."
LTO recently presented a plan on how the sector will ensure that farms stay Q-fever free. The plan involves vaccination and early disposal of infected animals in conjunction with milking prolonged for 2 years or more without gestation. The Ministry of Agriculture is undecided about the plan as yet."

November 18 2009~ The
excretion of Q-fever bacteria by goats varies during the
season.

"...Therefore
the number of infected farms will also vary in the course of the years,
according to Piet Vellema of the Animal Health Service (GD Deventer) and
Hendrik-Jan Roest of the Central Veterinary Institute (CVI) of the Wageningen
UR. The first round of bulked-milk research shows that 76 dairy goat
farms and 1 dairy sheep farm are infected with Coxiella burnetii, the bacterium
that causes Q fever. Researchers stress that not all infected farms are a risk
to public health. The location of the infected farms is similar to the image of
the infected farms that had more to do with abortion outbreaks, said GD. Most
companies were in North-Brabant (in the south of the Netherlands), but infected
farms were also found in other provinces. The researchers cannot say as
yet how many businesses are high and how many low infected.

"We do not know
where to draw the line," says Roest. "During the season the excretion of the
bacteria varies. In the lambing period the excretion is higher than in the rest
of the season. This is because the bacteria can thrive better in the goat during
pregnancy. We expect that bulk milk testing in 2010 will show more infections in
the lambing season of than we see now, "said Vellema. "Unless the vaccination in
the short term will be even more effective than we think there will also be
farms with low excretion scores and those will sometimes be detected and other
times not. "That seems a nuisance, but it is all about the risk that farms
represent regarding human health. The risk to human health also varies from
season to season, just like the bulk milk results. Farms with low excretion
scores are not really a risk," Roest explains.

November 16 2009 ~ "I have found a good article in "Emerging Infectious Diseases", EID, published by CDC and one can read all their articles free of charge..." writes Ruth Watkins

Dr Watkins continues, "In the 1999 May June Vol 5 No3 Q fever in Bulgaria and Slovakia is to be found. The abandonment of collectivised farms in Bulgaria, where cattle and sheep were more frequently infected with Q fever than goats changed in the 1990s to the now greatest number of goats and when the keeping of goats on small holdings in and around villages became the pattern of agriculture with the emphasis on self sufficiency- sheep numbers declined sharply. It seems clear to me from the article that

Much unpasteurised milk is drunk in Bulgaria

Little Q fever vaccination has so far been practised in Bulgaria

Standards of veterinary practice and hygiene are likely to be low, especially in goat sheds

The goats are taken out to graze during the day but then brought back home to sheds I imagine at night

The goats are kept near to people so contaminated dust can be spread in many ways- on clothes, in the air and so on.

Goats are not more susceptible than other species. In fact it is another lesson to me of how bacteria can be so widespread in nature ( like salmonella typhimurium and mycobacteria bovis for instance)- mammals, birds, reptiles and even fish can be infected by C burnetii. Spread by ticks is likely to be the most important way the organism is maintained in wild animals. (We had a patient at St Georges who died of meningoencephalitis with acute Q fever infection, and the only contact we could think of was by tick bite as she had just returned from a dog grooming course in Canada. I am sure she would never have been diagnosed in most hospitals but we had a brilliant professor of infectious diseases, Professor Harold Lambert)

Obviously intensive farming of goats where they spend their whole lives inside is not the only way that domestic animals can be a source of infected dust. Birthing in a dry and sheltered environment even by small numbers of infected animals passing infected birth products and placentas, perhaps without abortion, can also create contaminated dust. The intensive farming is simply likely to lead to huge concentrations or numbers of C burnetii when a 1000 goats are birthing.

I am not sure how often there is a persistent infection allbeit subclinical with C burnetii, but this is what is stated in my text book (the chapter is far too short), "persistent subclinical coxiellosis". I cannot find studies where abortion is repeated and shown to be due to C burnetii in animals- a recrudescence in pregnancy- however it has long been known that the titre of C burnetii is greatest in birth products, amniotic fluid and the placenta, I believe because of the sugars present favouring the growth of the organism. In the test book it states that a bull was infectious for 2 years via the semen with an exclamation mark. I expect there is a spectrum of disease and I expect many animals have an acute infection that their immune system clears as in humans.

The diagnostic antibody tests are not entirely satisfactory.
CF refers to complement fixation to test for antibodies to phase 1 or phase 2 forms of the bacteria. This will not pick up all infections, it has a lowish sensitivity.
Micro-immunofluorescence MIF is more sensitive but requires skilled and time consuming preparation of testing slides and some skill to do, reading a visual endpoint and distinguishing non-specific immunofluorescence.
ELISA is the most objective and the preparation of materials goes much further than MIF. I am not sure what commercial ELISAs there are on the market, one can also test for IgG, IgM and IgA as one can by MIF. The patterns and titres of these antibodies help define past infection, acute infection, and chronic persistent infection. I expect this level of refinement is only done on humans.
Indirect immunofluorescence on tissues especially if monoclonal antibodies can be used is done on placental products- it must depend on how decomplsed they are. PCR would be the best.

The reference to the vaccination against Q fever in humans being at worst an itch in a promed posting is disingenuous. If one has had Q fever already there is a fierce local reaction when the whole killed C burnetii organisms are given in vaccine at the vaccine site. Therefore humans are screened for past infection before vaccination. There are efforts now to remove the lipid A from the C burnetii organisms in the preparation of the vaccine to reduce this side effect, but I am not sure if the vaccine is sufficiently protective. Phase 1 organisms must be used in the vaccine to give protection, not phase 2. The immunity to be raised to this bacterium is complex and because it is an intracellular infection lymphocytes must be activated specifically to respond to give intra-cellular killing, not just antibodies that increase phagocytosis by macrophages (rather as with TB).

best wishes Ruth"

November 14/15 2009 ~ The Q fever organism is so infectious to work with in the laboratory that it is only cultured in very high containment facilities - "They really have a problem..."

The virologist, Dr Ruth Watkins, writes on the subject of the connection between intensive farming and pathogens such as the Q fever bacterium:

"....I am glad you have drawn attention to Q fever in the Netherlands. It has developed into the current epidemic because of intensive goat farming systems where animals do not go outside but live their whole lives in a shed in large numbers to provide a milking business. ...Those farms where infection has occurred in the Netherlands will be heavily contaminated with Q fever and a source for years to come. It is not only humans that are susceptible (one organism inhaled can cause infection) but also other domestic animals such as sheep, cattle, dogs and cats.
......
The numbers of reported human cases in the Netherlands are bound to be an underestimate. ... if vaccination of goats is the only measure taken the infection will continue to spread ...It may already be quite widespread in other domesticated animals where it may be sustained and continue to be a significant source of infection....
There is a lot to be said for allowing animals natural living conditions.
.."

November 14 2009 ~ The zoonosis, Q fever, in the Netherlands has affected 2200 people so far this year - at least 6 fatally.

The Netherlands is suffering from the largest Q
fever epidemic ever reported globally and new measures were recently decided upon by the Ministry. Q ("Query") fever provides a good example of where animal and human health policies need to work closely together and be aware of the other's difficulties. The Royal Dutch
Veterinary Society (KNMvD) in a recent newsletter: (See ProMed posting 20091004.3452)

"Ministers
Klink [public health] and Verburg [agriculture] intend to reduce the number
of human cases by these measures, but they warn against excessive optimism
in the short term: a reduction in the number of Q-fever patients is not
expected in 2010, at most, stabilization is expected. This is related to
the fact that the animal vaccine, while in state to prevent mass abortions
on the animal holdings, thus eliminating a significant source of infection,
is not capable of suppressing the disease altogether. Another point of
significance is the fact that the Q fever bacterium will survive in the
environment among dust particles."

Interestingly, the moderator adds that the Society "encouraged practitioners to
stimulate their client-farmers to report even sporadic abortions" in sheep
and goats - adding significantly

"Obviously, such stimulation is not sufficient if farmers fear
resulting repercussions."

In other words, farmers cannot be expected to go to great lengths to bring about difficulties for themselves - unless their public spirited behaviour is recognised and to some extent rewarded.The ProMed moderator (AS) said in October (here) , "Various aspects of this outbreak remain enigmatic, in particular its
epidemiology within the animal population, the interface with humans, its
dimensions and the role of climate/weather conditions.."

November 14 2009 ~ How serious is Q fever?

It is caused by the bacterium Coxiella burnetii and can cause abortion in animals. Humans can be infected by close contact with infected livestock, especially during lambing, but the bacterium can also travel some distance in the air. We read on ProMed today that
2200 people in the Netherlands have contracted Q fever so far in 2009 and human Q fever cases are no longer entirely restricted to the southern vaccination areas (map.pdf). At least 6 people have died. The disease has spread across a third of the
country and it seems that there is concern that it might be causing premature births in humans.
It may be remembered that during the foot and mouth mass animal killings of 2001 several emergency cull workers in Britain contracted the disease. It can cause flu-like symptoms and at worst can lead
to pneumonia - even to death.

Email received from Dr Ruth Watkins November 14 2009

Dear Mary

I don't know if you remarked an email on promed on the 12 Nov on the disease of columnaris in fish caused Flavobacterium columnare. (Yes. Fish farming can make diseases more virulent, say researchers)
The article describes how fish farming, an intensive farming business, enables more pathogenic flavobacteria to be selected and continue transmission as there is such a large number of susceptibles who are in contact with a diseased fish. Such bacteria would not be selected for in natural extensive fish living conditions in the sea or fresh water. This reminds me of highly pathogenic influenza which is selected for in intensive poultry systems.

The other danger of intensive farming is the accumulation of enormous numbers of organisms in comparison with extensive or more 'natural' farming conditions.

I am glad you have drawn attention to Q fever in the Netherlands. They have done too little about it too late- I ..have sent emails over the last year or so about Q fever drawing attention to the seriousness of the situation. It has developed into the current epidemic because of intensive goat farming systems where they do not go outside but live their whole lives in a shed in large numbers to provide a milking business.

They really have a problem. Q fever organisms may remain viable for decades in dust- there was an outbreak in Cardiff thought to be caused by taking down an old building where straw contaminated with spores had been stored or used in the fabric. Q fever occurs worldwide except in New Zealand! Those farms where infection has occurred in the Netherlands will be heavily contaminated with Q fever and a source for years to come. It is not only humans that are susceptible (one organism inhaled can cause infection) but also other domestic animals such as sheep, cattle, dogs and cats.

The organism is so infectious to work with in the laboratory that it is only cultured in very high containment facilities and all personnel working in such facilities are vaccinated because infection would seem to be unavoidable. Actually diagnosis of infection with Coxiella burnetii is quite difficult to do well and involves the preparation of reagents to detect immunogobulin types G, M and A to phase one and phase two Q fever antigens. It is best done in the UK by Dr Lloyd's containment level 4 laboratory at Porton Down where he prepares the reagents.

The diseases Q fever causes in humans, and I suspect also in other animals, are various. C burnetii is not only associated with abortions and pneumonia, but also with recurrent fever, hepatitis acute and chronic, cardiac disease- infection of the valves which can be fatal, and disease of the central nevous system, a meningoencaphalitis which can give rise to strokes and can also be fatal. Chronic disease is difficult to diagnose and treat and may need long term monitoring and follow up and may have limited responsiveness to long courses of tetracyclines or any other newer drugs that may have activity against Coxiella burnetii. Chronic infection with Q fever is usually way down on the list of diagnoses to be worked through methodically, and the specialist diagnostic antibody tests are essential- for instance in chronic hepatitis very high levels of IgA and IgM antibodies may occur not only to phase one antigens but also phase two. As response to therapy occurs in the liver so may the titres of antibody fall; follow-up may have to be indefinite.

The numbers of reported human cases in the Netherlands are bound to be an underestimate. Seroepidemiology on the human population and close monitoring of the situation in domestic animals is necessary to understand the extent of the Q fever outbreak. I expect the Netherlands are sensitive about doing this as it is a bad advertisement for tourism for example. Also I hope unpasteurised goat's milk and its products are banned. There should be active surveillance on all sheep and goat milking farms. Also on cattle dairy farms in the areas near known infected farms. I believe they should consider banning intensive goat farming for milk, likewise such sheep farming. On the farms where large outbreaks have occurred dismantling and burial of the buildings and their associated organic matter and dust should be considered, under continuous rain!

These sound like extreme measures but if vaccination of goats is the only measure taken the infection will continue to spread throughout the goat intensive dairying industry in the Netherlands, and to any such sheep intensive dairying industry. It may already be quite widespread in other domesticated animals where it may be sustained and continue to be a significant source of infection. It may be that small flocks of goats or sheep used for milking that are vaccinated, grazed outside, and kidded or lambed under guidance and monitoring of all premature abortions and miscarriages will not prove to be a risk of significant Q fever infection and source for other animals including humans.

There is a lot to be said for allowing animals natural living conditions.

best wishes

Ruth Watkins

UPDATE received from Dr Watkins an hour later...

I should point out that luckily the chronic infections and disease of the heart and liver, and recurrent fevers, are unusual in humans. This does have a bearing on the goats on the farms I would propose to close in their present form of 100s of goats living all their lives in one shed, one space. Goats are overwhelmingly likely to have acute infection with C burnetii that they clear. (I don't believe that a latent form of Q fever infection is known of)

The goats that have had an infection (could be screened for on serology) are the best immunised of all and there is no need to end their lives because of Q fever. The non-immune goats should be immunised some months before they are put to the billy. The spread of the organism in the environment arises primarily from placental products and infection of the placenta, with or without abortion, and this occurs in those goats infected during pregnancy or perhaps shortly before becoming pregnant. If the goats are grazing outside, not in holding pens and given hay, but properly outside, with grasses and scrub, they are unlikely to be exposed to infection at all, and even if brought in to kid in the final few weeks of pregnancy, will not therefore have infected placentas and amniotic fluid. That is probably why Q fever is not a big problem in Wales, because even though there are large flocks of ewes, 1000 or so, they are outside and either lamb outside or if inside are only brought in shortly before lambing.

Chlamydiale psittaci is a problem in sheep, perhaps because they infect each other by the respiratory route, but this also has the same proclivity as C burnetii for the placenta and infection can be spread by placental products. If ewe lambs are vaccinated at least 6 weeks before their first mating with the ram with a live Chlamydiale psittaci vaccine they are protected from infection during pregnancy and enzootic abortion (this is what I do with my small flock of sheep and every abortion is investigated, few so far, and where a cause found it has been an untypable campylobacter or an E coli infection). Toxoplasma gondii in sheep can also cause outbreaks of abortion with primary infection in pregnancy, but this is due to contamination of pasture with oocytes in faeces shed from young cats for about 3 weeks after the cats are first infected themselves. Again if this is a problem (I don't have young cats about) vaccine can be obtained most years, again a live vaccine given at least 6 weeks before tupping.

C psittaci can be associated with abortions in humans and T gondii also, and tragically the latter is also associated with foetal damage, most commonly to the retinae, also the damage can be severe to the brain and also fatal exactly in the same way as in lambs. The standard advice is that pregnant women should not go near the lambing shed or have anything to do with lambing ewes inside or out.

ends

September 29 2009 ~ Compulsory vaccination against the zoonosis, Q fever, in Holland from next year

As ProMed tells us, the Dutch Q fever outbreak is the largest of its kind on record. "...the number of human infections
with Q fever, since the start of this epidemic in mid 2007, is 3313
...
Out of the 2145 cases
reported so far during 2009, 2047 have been laboratory confirmed, 98
suspected; 5 died." On 26 September 2009 www.agd.nl reported that all premises with more than 50 milk goats or sheep (and also children's farms) will have to vaccinate their animals against Q fever ( for description of Q fever see wikipedia.org - as from next year. Agriculture Minister, Gerda Verburg, told the Dutch House of Commons that one and a half million doese of vaccine -the whole available stock - has been ordered. It is hoped that these measures will reduce the number of human cases of Q fever. ("The chronic form of Q fever in humans is virtually identical to inflammation of the inner lining of the heart (endocarditis),[8] which can occur months or decades following the infection. It is usually deadly if untreated", says Wikipedia)

Email received from Ruth Watkins December 13 2009

I think the vets are right.

1. I think individual goats sheep should be
tested, using PCR on a milk sample. One could do them in batches of 10 and
then if there is a positive batch then test each one individually. One may have
to do this after birthing as milk in any quantity is not available before
birthing.

2. On farms where there is known to be Q fever the
goats sheep could be treated with tetracycline starting at least 2 weeks before
kidding lambing is due and continuing for a week afterwards. It should be
given in the drinking water as injection would spread bloodborne Q fever
infection further. The water would have to be in buckets or troughs so
that the correct concentration would be achieved, not in self filling bowls as
it would be diluted. The other possibility is to put tetracycline in the
feed. The goal here is to suppress Q fever infection at the time of
birthing so reducing the environmental contamination. Humans take
tetracycline for many weeks at a time, I did for 6 weeks at the first few
lambings I was so concerned with catching psittacosis or Q fever from the
sheep.

3. There should be a policy of water washing
removal of conception products onto manure heaps or whatever is deemed the best
practice, after every birth without delay, so no dust forms. Veterinary
supervision of every dairy farm with Q fever should be done, the correct dosing
of the water etc and the methods for removal of conception products. Dust
clean up in general will be necessary.

4. Infected goats sheep can be followed up to
see if their infection is chronic, PCR on milk of goats and perhaps on vaginal
swabs or faeces from sheep, I am not sure what the shedding patterns are for
the Q fever strains in Holland are, they should jolly well know this by
now!. It would seem from what I have read that for goats the main shedding
route is the milk and in the case of sheep may be other routes as well.
All uninfected goats sheep PCR and serology negative after kidding should be
vaccinated. In the case of chronic infections perhaps goat mutton or sheep
mutton before putting back to the billies or rams would be the best
option. Past infections which are not chronic could be followed up, to
learn more about the disease, does it reactivate?

5. The testing would be very expensive and
may be best applied after kidding lambing. Obviously milk with
tetracycline in it will not be saleable but this is a small price to
pay.

6. Instead of just killing everything
and learning very little this would be a way of containing the situation.
Spread at the abattoirs is certain, and possibly en route from births in the
transport, and there is still the removal of infected dust at the farms to be
worked out too.